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Obstetric risk factors for anal sphincter trauma in a urogynecological population

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Abstract

Introduction and hypothesis

Obstetric anal sphincter tears are the single major modifiable risk factor for anal incontinence (AI) in women. We undertook a retrospective observational study in a tertiary urogynecology unit to describe the prevalence of sonographic anal sphincter defects in a urogynecological population and investigate obstetric risk factors.

Methods

Files of women seen for investigation of pelvic floor disorders between January 2014 and May 2021 were reviewed. Sonographic defects of the external anal sphincter were analyzed using stored 4D ultrasound imaging data. Explanatory parameters were number of vaginal births, delivery mode, age at first vaginal birth, and birthweight of the first vaginally born baby.

Results

Of 3,037 women seen during the inclusion period, data were missing in 219, leaving 2,818. AI was reported by 508 (18%), with a mean St Marks score of 11 (1–23) and a mean bother score of 5.9 (0–10). External sphincter defects were detected in 945 women (34%), with a “residual defect” in 343 (12%). The strongest risk factors for a residual defect were first vaginal birth and forceps, with higher-order multiparity adding risk. On multivariate analysis, forceps and vaginal parity >5 remained significant predictors, as opposed to age at first birth and birthweight of the firstborn.

Conclusions

In this observational study in urogynecological patients, 12% showed a residual EAS defect on imaging. The most obvious risk factors for the diagnosis of a residual defect on exo-anal imaging were the first vaginal birth and forceps, with higher-order vaginal parity conveying additional risk.

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Authors and Affiliations

  1. Sydney Urodynamic Centres, Suite 2, Level 1 56 Kitchener Pde, Bankstown, NSW, 2200, Australia

    Hans Peter Dietz & Ka Lai Shek

  2. The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia

    Gary Low

  3. Obstetrics and Gynaecology, Western Sydney University, Sydney, New South Wales, Australia

    Ka Lai Shek

Authors
  1. Hans Peter Dietz
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  2. Gary Low
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  3. Ka Lai Shek
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Contributions

H.P. Dietz: study design, data collection, manuscript writing; G. Low: data analysis; K.L. Shek: data collection, manuscript writing.

Corresponding author

Correspondence to Hans Peter Dietz.

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Conflicts of interest

H.P. Dietz has received lecture honoraria and travel assistance from GE Medical, Maternal Inc., and Mindray. The other authors have no conflicts of interest to declare.

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Dietz, H.P., Low, G. & Shek, K.L. Obstetric risk factors for anal sphincter trauma in a urogynecological population. Int Urogynecol J 34, 425–430 (2023). https://doi.org/10.1007/s00192-022-05404-1

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  • DOI: https://doi.org/10.1007/s00192-022-05404-1

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